Provider Demographics
NPI:1548794464
Name:ELDRIDGE, JUSTIN L (LPTA)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:L
Last Name:ELDRIDGE
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14830 TEAL DR
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-2402
Mailing Address - Country:US
Mailing Address - Phone:440-417-4357
Mailing Address - Fax:
Practice Address - Street 1:3720 N RIDGE RD W
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-6366
Practice Address - Country:US
Practice Address - Phone:440-261-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA001257225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant